title: Clinical outcome and economic impact of aminoglycoside peak concentrations in febrile immunocompromised patients with hematologic malignancies.
abstract: The aim of this study was to investigate the clinical and economic significance of aminoglycoside peak concentrations in febrile neutropenic patients with hematologic malignancies. Sixty-one patients were treated according to protocol II of the Paul-Ehrlich-Gesellschaft: initial application of gentamicin or tobramycin in combination with a cephalosporin or ureidopenicillin and, after 3 days, a potential change of antibiosis to be decided in case of nonresponse. At the same time, samples were collected by an independent controller. We found a significant dependence of clinical outcome on aminoglycoside peak concentrations (P = 0.004). Twelve of 17 patients with peak concentrations > 4.8 mg/L, but only 13 of 44 patients with concentrations < or = 4.8 mg/L, responded to initial therapy. Average infection-related costs per patient with peak values > 4.8 mg/L were US$1429, $1790, and $1701 for nursing, diagnostics, and therapeutics, respectively (total $4920). Expenses for patients with peak concentrations < or = 4.8 mg/L were approximately 1.8-fold higher (average total $8718). If all 61 patients had achieved peaks > 4.8 mg/L, the potential savings would have totalled $167,112. We conclude that neutropenic patients form a target group for successful pharmacokinetic intervention and cost saving.
authors.affiliation: Department of Clinical Chemistry, Georg-August-Universitaet Goettingen, Germany. Lbinder@med.uni-goettingen.de
authors.forename: L
authors.initials: L
authors.lastname: Binder
authors.forename: X
authors.initials: X
authors.lastname: Schiel
authors.forename: C
authors.initials: C
authors.lastname: Binder
authors.forename: C F
authors.initials: CF
authors.lastname: Menke
authors.forename: S
authors.initials: S
authors.lastname: Schüttrumpf
authors.forename: V W
authors.initials: VW
authors.lastname: Armstrong
authors.forename: M
authors.initials: M
authors.lastname: Unterhalt
authors.forename: N
authors.initials: N
authors.lastname: Erichsen
authors.forename: W
authors.initials: W
authors.lastname: Hiddemann
authors.forename: M
authors.initials: M
authors.lastname: Oellerich
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000191:economics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D002511:Cephalosporins / Q000627:therapeutic use; D016903:Drug Monitoring; D005260:Female; D005334:Fever / Q000150:complications*; D005839:Gentamicins / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D011379:Prognosis; D014031:Tobramycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D002511:Cephalosporins; D005839:Gentamicins; D010406:Penicillins; D014031:Tobramycin